Paracoccidioidiomycosis: case report

Os autores reportam o caso clínico de um homem, 43 anos de idade, natural e residente na ilha da Madeira, emigrado na Venezuela até há 6 anos. Em Março 2009, observado por aparecimento de lesão pápulo-crostosa de bordos regulares eritematosos, indolor, pruriginosa, com dimensões de 4,5 x 3 cm, localizada no dorso, com 2 meses de evolução. Como antecedentes, refere história de lesão da mucosa bucal, com exame histopatológico compatível com paracoccidioidomicose (PCM). Foram efectuadas duas biópsias da lesão cutânea para avaliação histopatológica e micológica. O exame histopatológico revelou a presença de múltiplas células circulares, sugerindo distribuição característica de “roda de leme”. O estudo micológicos revelou, no exame directo, a presença de leveduras – algumas em gemulação. As culturas permitiram isolar o Paracoccidioides brasiliensis. A radiografia pulmonar apresentava infiltrado bilateral e simétrico, nos lobos centrais e basais. A Tomografia Axial Computadorizada torácica demonstrou múltiplos nódulos espiculados, áreas de opacidade e bronquiectasias. Foi efectuada broncofibroscopia (sem alterações) e simultaneamente foi obtido o lavado broncoalveolar (LBA). A cultura, a 25º C, revelou a presença de hifas e clamidósporos (forma filamentosa). Na cultura, a 37º C, não se obteve a forma leveduriforme. O tratamento efectuado foi o itraconazol 200 mg/dia, durante 6 meses, com regressão da lesão. Até à actualidade, nenhum caso de PCM foi reportado na ilha da Madeira, Portugal. Embora não seja frequente, fora das áreas endémicas, os dermatologistas devem ser capazes de reconhecer e diagnosticar micoses sistémicas, como a PCM.We report a case of a 43 years-old portuguese man, natural and resident in Madeira island, who was emigrated in Venezuela until 6 years ago. He was observed on March 2008 for a crusted papulo-nodular lesion with erythematous regular borders, pruritic and sized 4,5 x 3,0 cm, located on the dorsum, with a 2 month history. There was no palpable lymphadenopathy. He denied other simptomatology. On March of 1999, the patient had a mouth lesion which was compatible with paracoccidioidomycosis on histopathological examination. He was not aware of any associated pathologies. We performed two punch biopsies of the cutaneous lesion for histopathological and mycological examination. The histopathology showed the presence of multiple round cells of different size (yeast cells) in a narrow base suggesting the classic “pilot’s wheels”, on Hematoxiline & Eosine stain. On direct microscopic examination the mycology revealed yeast of different sizes – some of them on gemulation. The cultures, at 24º and 37º, isolated Paracoccidioides brasiliensis. The thoracic x-ray revealed a heterogeneous, bilateral and symmetric pattern located towards the central and basal portions. The CT scan of the chest showed multiple, micronodular and striated lesions (some of them with small cavities), with tendency to coalesce. To characterize better these lung abnormalities, the patient performed a fibrobronchoscopy of the respiratory tract which was normal. The culture, at 25 ºC, obtained from the sputum of the bronchoalveolar lavage fluid (BAL) showed Paracoccidioides brasiliensis. Routine laboratory studies were normal and serology negative for HIV and tuberculosis. The treatment of choice was itraconazol 200 mg/day, for 6 months. As far as we know no case of PCM has been reported in Madeira. Although it is not a frequent disease outside the endemic areas, dermatologists should be able to recognise and diagnose systemic mycosis like PCM.info:eu-repo/semantics/publishedVersio

Mediation of area and edge effects by adjacent land use.

Habitat loss, fragmentation and degradation have pervasive detrimental effects on tropical forest biodiversity, but the role of the surrounding land use (i.e. matrix) in determining the severity of these impacts remains poorly understood. We surveyed bird species across an interior-edge-matrix gradient to assess the effects of matrix type on biodiversity at 49 different sites with varying levels of landscape fragmentation in the Brazilian Atlantic Forest - a highly threatened biodiversity hotspot. Our findings revealed that both area and edge effects are more pronounced in forest patches bordering pasture matrix, while patches bordering Eucalyptus plantation maintained compositionally similar bird communities between the edge and the interior, in addition to exhibiting reduced effects of patch size. These results suggest that the type of matrix in which forest fragments are situated can explain a substantial amount of the widely-reported variability in biodiversity responses to forest loss and fragmentation. This article is protected by copyright. All rights reserved

Portuguese propolis: a source of valuable bioactivities

To FEDER/COMPETE/POCI– Operational Competitiveness and Internationalization Programme, under Project POCI-01-0145-FEDER-006958 and FCT - Portuguese Foundation for Science and Technology, under the project UID/AGR/04033/2013

Elevated Risk for HIV-1 Infection in Adolescents and Young Adults in São Paulo, Brazil

Background. Recent studies have sought to describe HIV infection and transmission characteristics around the world. Identification of early HIV-1 infection is essential to proper surveillance and description of regional transmission trends. In this study we compare people recently infected (RI) with HIV-1, as defined by Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS), to those with chronic infection. Methodology/Principal Findings Subjects were identified from 2002-2004 at four testing sites in São Paulo. Of 485 HIV-1-positive subjects, 57 (12%) were defined as RI. Of the participants, 165 (34.0%) were aware of their serostatus at the time of HIV-1 testing. This proportion was statistically larger (p<0.001) among the individuals without recent infection (n = 158, 95.8%) compared to 7 individuals (4.2%) with recently acquired HIV-1 infection. In the univariate analysis, RI was more frequent in <25 and >59 years-old age strata (p<0.001). The majority of study participants were male (78.4%), 25 to 45 years-old (65.8%), white (63.2%), single (61.7%), with family income of four or more times the minimum wage (41.0%), but with an equally distributed educational level. Of those individuals infected with HIV-1, the predominant route of infection was sexual contact (89.4%), with both hetero (47.5%) and homosexual (34.5%) exposure. Regarding sexual activity in these individuals, 43.9% reported possible HIV-1 exposure through a seropositive partner, and 49.4% reported multiple partners, with 47% having 2 to 10 partners and 37.4% 11 or more; 53.4% of infected individuals reported condom use sometimes; 34.2% reported non-injecting, recreational drug use and 23.6% were reactive for syphilis by VDRL. Subjects younger than 25 years of age were most vulnerable according to the multivariate analysis. ) Conclusions/Significance In this study, we evaluated RI individuals and discovered that HIV-1 has been spreading among younger individuals in São Paulo and preventive approaches should, therefore, target this age stratu

An unusual case of an isolated capitellar fracture of the right elbow in a child: a case report

<p>Abstract</p> <p>Introduction</p> <p>Although elbow fractures have a high incidence in the pediatric population, fractures of the capitellum are almost exclusively observed in individuals older than 12 years of age. Due to their rarity in children, reports with large numbers of cases are lacking in the literature and the surgical treatment options are poorly defined.</p> <p>Case presentation</p> <p>We present the case of an 11-year-old Portuguese girl with a displaced fracture of the capitellum of the right elbow, a typical Hahn-Steinthal or Type 1 fracture, which was followed for one year. The treatment and outcome of this fracture are described. Our patient underwent an open reduction and internal fixation with two cannulated screws. There were no complications and normal elbow function was recovered.</p> <p>Conclusion</p> <p>The authors believe that cannulated screw fixation is a reliable method of treatment for Type 1 capitellar fracture in children because it enables good interfragmentary compression, early mobilization, faster functional elbow recovery and implant removal is rarely necessary.</p

Impact of a physical activity program on the anxiety, depression, occupational stress and burnout syndrome of nursing professionals

OBJECTIVE: to assess the effects of a workplace physical activity (WPA) program on levels of anxiety, depression, burnout, occupational stress and self-perception of health and work-related quality of life of a nursing team in a palliative care unit.METHODS: the WPA was conducted five days per week, lasting ten minutes, during three consecutive months. Twenty-one nursing professionals were evaluated before and after the intervention, with the Hospital Anxiety and Depression Scale, the Maslch Burnout Inventory, and the Job Stress Scale. The changes in self-perceived health and work-related quality of life were measured using a semi-structured questionnaire.RESULTS: the WPA did not yield significant results on the levels of anxiety, depression, burnout or occupational stress. However, after the intervention, participants reported improved perceptions of bodily pain and feeling of fatigue at work.CONCLUSION: the WPA did not lead to beneficial effects on occupational stress and psychological variables, but it was well accepted by the nursing professionals, who reported improvement in perceptions of health and work-related quality of life

Comparison of venous plasma glycemia and capillary glycemia for the screening of type 2 diabetes mellitus in the Japanese-Brazilian community of Mombuca (Guatapará-SP)

<p>Abstract</p> <p>Background</p> <p>To identify the most appropriate cut-off points of fasting glycemia for the screening of diabetes mellitus type 2 (DM2) with the comparison of the properties of capillary glycemia (CG) and venous blood plasma glycemia (PG) in a population of Japanese origin from the community of Mombuca, Guatapará - SP, Brazil.</p> <p>Methods</p> <p>This was a population-based descriptive cross-sectional study conducted on a sample of 131 individuals of both genders aged 20 years or more (66.8% of the target population). CG was measured with a glucometer in a blood sample obtained from the fingertip and PG was determined by an enzymatic method (hexokinase) in venous blood plasma, after a 10-14 hour fast in both cases. Data were analyzed by the receiver operating characteristic (ROC) curve in order to identify the best cut-off point for fasting glycemia (CG and PG) for the diagnosis of DM, using the 2-hour plasma glycemia > 200 mg/dl as gold - standard.</p> <p>Results</p> <p>The ROC curve revealed that the best cut-off point for the screening of DM was 110 mg/dl for CG and 105 mg/dl for PG, values that would optimize the relation between individuals with positive and false-positive results. The area under the ROC curve was 0.814 for CG (p < 0.01) and 0.836 for PG (p < 0.01).</p> <p>Conclusions</p> <p>The cut-off points of 105 mg/dl(5.8 mmol/l) for PG and of 110 mg/dl(6.1 mmol/l) for CG appear to be the most appropriate for the screening of DM2 in the population under study, with emphasis on the fact that the value recommended for CG is 5 mg/dl higher than that for PG, in contrast to WHO recommendations.</p